Papilledema is swelling of the optic disk secondary to increased intracranial pressure → classically bilateral but (as in the video example) may be unilateral
- Optic disk swelling resulting from causes that do not involve increased intracranial pressure (eg, malignant hypertension, thrombosis of the central retinal vein) is not considered papilledema.
- There are no early symptoms, although vision may be disturbed for a few seconds. Papilledema requires an immediate search for the cause
Diagnosis is by ophthalmoscopy with further tests, usually brain imaging and sometimes subsequent lumbar puncture, to determine the cause
- MRI or CT scan of the head looking for a cause. Focus on finding intracranial pathology = tumor or bleed, cerebral edema, CSF outflow obstruction or overproduction
- Increased opening pressure with lumbar puncture confirms increased intracranial pressure
Causes include the following:
- Brain tumor or abscess
- Cerebral trauma or hemorrhage
- Meningitis
- Arachnoidal adhesions
- Cavernous or dural sinus thrombosis
- Encephalitis
- Idiopathic intracranial hypertension (pseudotumor cerebri), a condition with elevated CSF pressure and no mass lesion
Urgent treatment of the underlying disorder is indicated to decrease intracranial pressure.
- If intracranial pressure is not reduced, secondary optic nerve atrophy and vision loss eventually occur, along with other serious neurologic sequelae.
Intracranial pressure (ICP) is a measure of the hydrostatic pressure in the brain. Three elements contribute to ICP: brain tissue, blood, and cerebrospinal fluid (CSF). While these elements usually remain in balance, factors such as an increased body temperature or increased arterial or venous pressures can cause the ICP to fluctuate. The Monro-Kellie doctrine states, that if one component of ICP (brain tissue, blood, CSF) increases, one of the other components will decrease to maintain a constant pressure. When this balance is disrupted or when compensatory mechanisms fail, increased ICP can result. Signs and symptoms of increased ICP include a change in the level of consciousness, headache, irregular respirations, widening pulse pressure, bradycardia, projectile vomiting, abnormal pupils, and decerebrate or decorticate posturing.
Increased Intracranial Pressure (ICP) Assessment | Play Video + Quiz |
Increased Intracranial Pressure (ICP) Interventions | Play Video + Quiz |
Question 1 |
CT scan of the head Hint: See B for explanation | |
lumbar puncture | |
therapy with high-dose prednisone Hint: See B for explanation | |
stat cerebral arteriogram Hint: See B for explanation | |
reassurance and follow-up in the office in 6 months Hint: See B for explanation |
References: Merck Manual · UpToDate